JCPM2025.08.26

The following is an edited transcript of the Journal Club with Pearls & Marketing (JCPM) of August 26, 2025, with Charles Runels, MD.  

>-> The PDF of this live journal club can be seen here <-<

Topics Covered

• The Evolution of Platelet Concentrates (PRP has become the “classic”)
• PRP-Derived Extracellular Vesicles Work Better for Ischemic Stroke After Exercise
• Acne Treatment: PRP plus Fibroblasts Better than PRP Alone
• What Buckminster Fuller & Leonardo Can Teach You about Marketing and Innovation
• An Email You Can Send
• References
• Helpful Links

Charles Runels, MD
Author, researcher, and inventor of the Vampire Facelift®, Orchid Shot® (O-Shot®), Priapus Shot® (P-Shot®), Priapus Toxin®, Vampire Breast Lift®, and Vampire Wing Lift®, & Clitoxin® procedures.

Transcript

Welcome to our Journal Club. We had several interesting papers out this week, and let’s plunge right in. If you hang on to the end, I have some marketing tips from Buckminster Fuller (whom I spoke about last night), but I’ll dive more into them today. The great inventor and architect legend who inspired Silicon Valley and was kicked out of Harvard (twice!) but was later awarded an honorary degree for his many inventions over his 87 years; he had some wisdom, I think, regarding how to talk about science and even about our procedures.

But first, a few papers came out (with a lot to say to us).

The Evolution of Platelet Concentrates (PRP has become the “classic”)

This first one is open source, so I’ll put it in the handout section when we’re done. It’s the best summary I’ve seen yet to review and explain the evolution of what they call platelet concentrates. If you actually look up the definition of our procedures, U.S. Patent and Trademark Office, I define them as blood-derived growth factors, including platelet-rich plasma, but acknowledging that there’s a lot in there to be thought about and talked about, and discovered how to use that maybe we didn’t know, this was 15 years ago.

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I had to chuckle when I read this first part of it because it says, “Platelet concentrates have evolved from classical formulations to exosome-based therapies, reflecting a paradigm shift in regenerative medicine.”^[1] 

The funny thing to me about that is PRP, which we’ve been using for 15 years in our group, 16 years, has been around for 10, 20 years before that in the orthopedic and dentistry fields. Yet, it’s still largely unused by our colleagues, largely misunderstood by our colleagues (in gyn and urology). And so on the one hand, we’re in this field where it’s old enough. PRP is called old-school classical, but most of our colleagues have not acknowledged its usefulness.

Talk about the left hand not knowing what the right hand is doing.

Historically, my favorite example of that is back in the 1980s when I was in medical school and the gynecologists were routinely doing surgeries with endoscopy, and the general surgeons were not; you went home with this huge scar in your right upper quadrant with a cholecystectomy. Literally in the same hospital in the adjacent OR, you had gynecologists easily doing hysterectomies endoscopically.

There are many versions of that throughout the history of medicine, but this is one version where it’s becoming more amusing that, on the one hand, this is decades old in dentistry. Now we’re a decade and a half in urogynecology and aesthetics of using platelet-rich plasma to the point where PRP is called old school, “classical.” And yet, if you just surveyed your colleagues, most are not employing it as one of the tools they use to care for their patients.

However, several charts here are worth having on hand to clarify some of the questions that often come my way.

For example, one of them is PRP versus PRF, and a lot of salespeople are selling PRF, and a lot of people in our group are using it. And for its place, it is wonderful in its place. This is the first comparative chart I’ve seen that made it easy to talk about. You can see PRP, which is listed for wound healing and orthopedics. We would fall in the category of wound healing and soft tissue repair. But once you get to PRF, because it becomes more methodically difficult to force it through a tiny needle, it becomes more about superficial tissue repair (NOT the P-Shot® or the O-Shot®), either wound care or certain parts of the face.

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Okay, so if you scroll down, you could study the charts in this article and get 90% of what it offers. We’ve talked about most of this in our Journal Clubs, the different ways to classify what they’re calling platelet concentrates, but most of this is regarding PRP preparations, and then it starts to advance to more with exosomes and other things.

So, as you know, many people are still debating what exactly PRP is and how many platelets you need to be effective, as well as different variations of activation, how many red blood cells versus not, and different types of white blood cells versus not. And practically speaking, from a clinician standpoint versus research, it’s always helpful for me to remember when a child falls down and scrapes their knee or we suture a wound, surgical or traumatic, we don’t have to think about all of that. The science is built into it. And the platelets do what they need to do without us understanding any of it.

So yes, it’s useful to figure out how to make things work better or how to change the composition for various indications. It’s also helpful, I think, to relax and realize that the platelets, the biochemistry of the thrombotic cascade, and the thrombin cascade take care of it. When you’re working with avascular tissue like the knee or in dentistry, maybe it becomes more critical. For a special indication, like we’re getting to a paper regarding infertility, things may change. But I think we can relax in that I honestly think you could almost do an O-Shot® with whole blood, especially if you activate it with calcium chloride just prior to the injection, and for many women, it would be just fine. Not recommending that. I think it works better when you isolate the platelets, and that makes a huge difference.

The hydrodissection also plays a part, so where you put the needle matters!

But this is the best summary of the classification. Then, here’s more of what I just talked about: different ways to think about activation methods and red blood cells versus leukocyte content.

Then there was one more chart: this summarizes the whole point of the paper, which is a little bit anticlimactic, or at least it leaves you without the wanted orgasm, because they present the problem, but there’s no easy solution. Because the idea is that perhaps the future’s headed towards exosome therapy, homologous autologous use, and the technology for standardizing that is not quite in place, at least that’s the point they’re making.^[2]

So, for now, this bears watching, and some of you may want to become involved in this sort of research. I mean, what’s the point of a journal club if you’re not keeping up with where the edge is? And part of what fuels research, of course, is being up-to-date. When you see the very most up-to-date discussions, the next idea you have is probably the best idea for your next research or your next idea. And the beauty, of course, with autologous homologous type work is that it’s safe. So if you have an idea, you can try it. If we know PRP works well in the knee, there’s really no need not to use it in the shoulder. If it works in the shoulder, why not put it in the penis? That was my thinking anyway, and it worked out.

Some of you are already doing some of this, but it organizes it very well in a framework.

I’m still a straight-up PRP guy. Some of the different sources of exosomes. Some of them make me concerned about the FDA coming to my door. I know the safety profile of PRP (homologous, autologous & minimally manipulated) use, and it’s working, so I feel okay with what I’m doing. But if I were in an arena like trying to regenerate nerves and spinal cord injury or help treat stroke, then I would want an IRB to see if some of this might work better, and that’s what’s happening in the research.

PRP-Derived Extracellular Vesicles Work Better for Ischemic Stroke After Exercise

Okay, this next one is also out this week. This one is looking at rats, and they showed that exercise improves the results of treating ischemic stroke with PRP-derived extracellular vesicles (including exosomes); they use these exercise-induced extracellular vesicles, just like we just talked about.^[3] It’s in rats.

It can’t be done yet in people. But you’re going to see this sort of thing being applied to our patients in our lifetimes, even in my lifetime, at over 65, we’re going to see this sort of thing being applied to our patients.

I ran a hospital-based hyperbaric chamber, and it was available for ischemic stroke, but I never saw it used for that. Of course, we used it mainly for wound care and the occasional case of bends since we’re on the Gulf of America. But with an aging population and an improving understanding of cell biology, this is where we’re headed.

Bottom Line: Your patients will have a better chance of a good outcome after any PRP procedure if they regularly do aerobic exercise.

Acne Treatment: PRP plus Fibroblasts Better than PRP Alone

Then, in this one, another futuristic paper, they cultured fibroblasts. They did a biopsy behind the ear, mixed that with PRP, and then compared it with PRP alone in treating acne scars.^[4]

There’s a little diagram of a double-spin centrifuge. And if you scroll down, they have pictures highlighting that they both worked, but the cultured fibroblast mixed with the PRP worked better.

Again, I’ve never cultured fibroblasts before. It’s a simple thing to have done, and I have to think about it because this would not be minimal manipulation. I think this was done outside the U.S., so I’m not sure how this would fly with the FDA; yeah, in Tehran. In the U.S., it breaks our rule of minimal manipulation.

It’s not technically a stem cell; it’s just a fibroblast, but remember that to be outside the FDA’s scope, it must be homologous, autologous, and minimally manipulated.

So, I don’t know how this could be done in the US unless it were under an IRB. But if some of you are looking for another research project, this is a fertile ground for possibilities.

One more paper and then some marketing tips.

Supercharge Sperm with Exosomes

Most of us are not practicing infertility. Still, we’ve discussed papers where they’ve improved sperm survival and fertility by using PRP since it should be part of what we know, but I haven’t seen exosomes used to enhance sperm until this paper came out.^[5]

So, platelet-rich plasma is used to collect exosomes, which is used to preserve human sperm.

Some of you are already using exosomes, but I worry about some of our sources, so just be sure: the question to ask of the salesperson wherever you’re buying them, if they’re not autologous, is, “Give me the paperwork that I would need to show the FDA if they knocked on my door.”

I found that to be the discerning question that makes most of them run away.

We’ve only had a couple of people who have had problems with the FDA, and it was never about PRP. Once, one of our members bought botulinum toxin from a source outside the US, and the other had to do with stem cells.

So, be careful. I’ve seen some dubious claims from some of the reps. That’s the discerning question.

What Buckminster Fuller & Leonardo Can Teach You about Marketing and Innovation

Okay, and then a quick marketing tip, and then I’m done.

This is my new guru, Buckminster Fuller, whom I’m reading a lot about. I talked about some last night, if those of you who come to the Cell Doctor Forum, where we talk more about protocols and this about research, but he wanted to talk more about how he thinks about just innovation and science in general. And it’s worth picking up this book, Critical Path.^[6] 

This was his last book. He was 85 when he wrote it and died at 87. The fourth chapter is his Rules of Living, which he developed as rules of living and thinking. I’ll give you some of my favorites or his rules.

One of them was that he thought innovation was best done outside of a for-profit company and outside of an institution because you’re allowed to think more freely. The best ideas would not come from politicians and institutions because their goals are different; they must make a profit or be re-elected, while the individual can be freer in thinking.

He called himself Guinea Pig B; B for Bucky, short for Buckminster, his first name, and considered his whole life an experiment.

And part of his experiment (I’m getting at my marketing tip, this book is full of tips) but my favorite tip from the book is that he did not just keep a journal, he kept an ongoing record of his life that wound up being tons of material receipts and clippings back before you could do it with the internet, and that’s now at Stanford, it’s tons of material that’s now being curated at Stanford University.

And so, the point I’m making from that is that, though he was not unusual in that practice, he took it to the Nth degree.

Still, he was not unusual in keeping a chronological record versus trying to alphabetize it or order it.

Over twenty years ago, I was lucky to come across How to Think Like Leonardo da Vinci. I was able to meet the author through a mutual friend—he’s brilliant. He first gave a version of this book as a lecture at one of those high-priced CEO meetings where there are multiple lectures going on at the same time, and they will walk out on you if you’re not good; he was good. So good, that the lecture became a book and more.

In his book, after much research, Michael Gelb talks about Leonardo da Vinci’s practices. One of them was keeping a notebook with him all the time. Leonardo’s goal was to one day organize it all, but he didn’t. So, what? The journals still worked for him.

Einstein did the same thing.

So did Jack London.

So did many other scientists.

Leonardo kept everything from recipes and jokes to scientific visions that would take centuries to materialize.

Various royalties were hiring him. One of his job descriptions when he was applying to be hired by the King was that he could entertain, host parties, and do magic tricks. He could play music and knew how to build instruments of war like nobody else could do. He could paint better than anybody.

Talk about a resume.

Of course, no one knows what his music sounded like, but he was a musician. What would you give to hear music that Leonardo da Vinci played?

Much of his art was sketches, done not to be art but to understand by drawing.

So, he had these massive amounts of notebooks that he kept. I know we keep notes on our patients, but you might think about having a little something that you carry around with you. I know it can be kind of nerdy to have a whole notebook. So, the option is if you’re going into a place where it’s just too nerdy or meeting or out to dinner, it’s a stack of index cards. You stick them in your pocket somewhere.

Another book that has helped me think is How to Take Smart Notes^[7].

This one is by a man who, in this latest version, studied one of the most prolific scientists ever, a sociologist in Germany. He wrote so many books and articles that people have made a science of how he could be so prolific. And he did not keep a notebook. He kept his notes on slips of paper and filed them in a box after he wrote them by category.

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So I’ve experimented with this (he called it his “slip box”).

And it’s not like I’m some Einstein, but what few little ideas I’ve had have evolved from that sort of thing—notes on everything, routinely, as a daily practice.

And here we have Buckminster, or Bucky, talking about how he took it to the Nth degree more than Leonardo, more than the German guy, more than Jack London, not just notebooks but files and files—literally tons of files.

His goal was to document his whole life and prove that an average guy who got kicked out of college could do well, and he did (do it and document it). He invented a type of car. He was an architect. He was brilliant in his productivity, but he largely attributed his success to his rules (don’t miss his last one; it’s how he thought about God).

Another rule was that he wanted to think about only what would help the most people (no duplication of what already existed and no innovation for a narrow field—like just helping one politician or one business).

So he always had his brain on what would be the most helpful, not self-promoting, just trying to understand and then offering it to the planet, which is how I suggest you do your marketing!

He was so widely read that it’s scary to read how much he studied different branches of science and really the whole planet, history, everything. He just read everything.

But his goal was to put his brain on what would be the most helpful, and then if he had a useful idea, it would be adopted without him having to promote it.

But people needed to know about it. Still, beyond announcing his new idea made concrete, because of the evolution of ideas, if he truly had something valuable, he thought he should NOT have to spend a lot of money advertising it, which is what you’ve heard me say over and over again, which I guess is why I like this guy.

He didn’t pay much to promote himself or his products; he just put them out there. He let people know they existed, and then he let the idea itself carry itself.

Another cousin of the idea will be found in the book I’ve often recommended, The Tipping Point,^[8] by Malcolm Gladwell, about how things go viral.

I read the thing probably six times when it first came out because things were going viral; it was the early days of the internet, and people were studying why that was happening. But things went viral way before the internet. P.T. Barnum never copyrighted his autobiography because he wanted it to go as viral as a book could go back then; so he wanted people to sell it without paying royalties, and it did. He had other ways he would make news about his circus and museum go viral, such as by using the press, basically letting people know about it.

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We’ve had many millions of dollars in free advertising because I let the press know what we do and let people know what we do without paying for ads.

I’m not sure what you do with all that, but it takes the pressure off because what you get to do is not trying to push your product.

Your mindset is, “I know how to do something. I know how to mix blood, spin it around, and put it somewhere that makes somebody’s life better.”

I need to let people know about it, so let me send out a little email or talk about it. I’m not trying to get anybody to do anything; I’m just letting them know what I do, and then when they come see me, I’ll make it easy for them to tell other people.

And I think with that, we’re up on the 30-minute mark, so I’m going to call it a day unless somebody has a question.

If I take what we talked about today and turn it into something that brings people to me who need me, I would take one of those papers, the one about the evolution of the different types of platelet concentrates, and send it… It’s open source.

You send that to your people; will they understand it?

I don’t understand all of it.

I understand most of it, but what they will know is, “Wow, you let them know where you fit into this category. Listen, this is the latest about blood-derived growth factors or platelet-derived growth factors. And they even say, these are the classic formulations we’re using. PRP has been around long enough. Don’t even think of it as new; it’s “classic,” it’s old school, and that’s what we’re doing.

It’s safe, and we now have decades of safety. There’s other stuff coming, and maybe you’re doing that too. If you are, let them know.

But otherwise, this is a well-developed science. This is not hokey voodoo.

This is well-developed and further developing science we understand in our office, and we know what we’re doing. Come see us; we can help you with your acne scars or incontinence (whatever it is you’re treating). And you put your phone number.

That isn’t self-promoting. It is educating people instead of somehow expecting them to read your mind and know what you do. It is educating people about what you are doing. Here’s the keyword: You’re offering to help them.

You’re letting them know what you know, and you’re offering to help.

Remember one of my favorite sayings from David Ogilvy: If you teach a person about their disease, they will trust you to treat it.

So, shoot that out, educating your people about what you know. Give them your phone number. You won’t get 100 calls, but you’ll get some calls. If you want something to inspire you, get Buckminster’s book Critical Path and read the chapter where he offers his rules, basically his ethics of how he organizes life and how he thinks about money and innovation.

I think we’ll call it a night. I hope that was helpful to you.

Good night.

_________________________________________________

Here’s an Email You Could Send

1. Copy and paste the following message into a new Word document.
2. Then edit it so that it sounds like you.
3. Add a story or a personal observation if you have time.
4. Then, fill in the information with your phone number, etc., and send it to your patients.

Hello [First Name],

When I read this paper about treating stroke in rats, I thought you may want to know how it relates to treating male sexuality.

In one group, the rats ran on the treadmill for 30 minutes three times a week for four weeks, while the other rats were stuck in their cages with no treadmill (like a person caged in a house, office, or car: stuck in a box and not walking).

Then, they gave the rats an ischemic stroke, followed by treating the rat brain with extracellular vesicles from PRP.

After treatment with the PRP derivative, the rats that ran/walked three times a week for four weeks recovered much better than those who did not.

We already have multiple double-blind, placebo-controlled studies showing that our P-Shot® procedure (using a specific way of preparing and injecting PRP) can help with male intimacy. And we already know that walking can increase function as much as taking medications. But now we know that the same aerobic exercise could help the healing process when you are injured and could improve the effects of a P-Shot® procedure.

Read the research, and you will want to go for a walk.

If you think this may help you or someone you know, you can find your nearest licensed P-Shot® provider here (click).<-

I hope this helps.

Sincerely,

(your name)
(your photo)
(your phone number)
More about the Priapus Shot® procedure<-
(link to your website)

_____________________________________

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References

Ahrens, Sönke. How to Take Smart Notes: One Simple Technique to Boost Writing, Learning and Thinking: For Students, Academics and Nonfiction Book Writers. CreateSpace, 2017.

Fuller, R. Buckminster. Critical Path. 1st ed. St. Martin’s Press, 1981.

Gladwell, Malcolm. The Tipping Point: How Little Things Can Make a Big Difference. 1st ed. Little, Brown, 2000.

Karimi, Fatemeh, Marzieh Kafami, Fatemeh Ghodrati Khakestar, Mohammad Hossein Madahali, Samad Nazemi, and Sareh Karimi. “Protective Effect of Exosomes Derived from Platelet-Rich Plasma during Human Sperm Cryopreservation.” Molecular and Cellular Biochemistry, ahead of print, August 19, 2025. https://doi.org/10.1007/s11010-025-05371-3.

Li, Youan, Huimin You, Chunhui Ou, Hongyuan Zhu, Biao Cheng, and Ju Tian. “The Evolution of Three Generations of Platelet Concentrates Products: A Leap from Classical Formulations to the Era of Extracellular Vesicles.” Frontiers in Bioengineering and Biotechnology 13 (August 2025): 1628565. https://doi.org/10.3389/fbioe.2025.1628565.

Miyauchi, Yoshifumi, Nobukazu Miyamoto, Toshiki Inaba, et al. “Exercise-Induced Extracellular Vesicles Derived from Platelet-Rich Plasma Improved Recovery after Ischemic Stroke.” Journal of Cerebral Blood Flow & Metabolism, August 20, 2025, 0271678X251369219. https://doi.org/10.1177/0271678X251369219.

Zare, Sona, Roya Zeinali, Maryam Nouri, et al. “Comparison Combination of Autologous Fibroblast Cells Plus Platelet Rich Plasma ( PRP ) With PRP Alone in Treatment of Atrophic Acne Scars, a Split‐Face Pilot Study With Biometric Assessment.” Journal of Cosmetic Dermatology 24, no. 9 (2025): e70413. https://doi.org/10.1111/jocd.70413.

Tags

platelet concentrates, platelet-rich plasma, PRP, PRF, exosomes, regenerative medicine, wound healing, orthopedics, dentistry, urogynecology, aesthetics, O-Shot, infertility, sperm preservation, ischemic stroke, extracellular vesicles, fibroblasts, acne scars, FDA regulations, homologous use, autologous use, minimal manipulation, Buckminster Fuller, Leonardo da Vinci, Einstein, Jack London, note-taking, innovation, marketing tips, viral ideas, The Tipping Point, David Ogilvy, Critical Path

Helpful Links

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